Provider Demographics
NPI:1992867923
Name:W BRIAN BYRD MD PA
Entity type:Organization
Organization Name:W BRIAN BYRD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-789-6333
Mailing Address - Street 1:6100 HARRIS PKWY STE 1240
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4248
Mailing Address - Country:US
Mailing Address - Phone:817-789-6333
Mailing Address - Fax:817-433-5177
Practice Address - Street 1:6100 HARRIS PKWY STE 1240
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4248
Practice Address - Country:US
Practice Address - Phone:817-789-6333
Practice Address - Fax:817-433-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00013XMedicare PIN
TXG97562Medicare UPIN